OPTIMIZE-2 the right dose.

Outcomes of the Phase 3 OPTIMIZE-2 trial were reported this month in JAMA Onc assessing de-intensification of bisphosphonate therapy. 412 women with breast cancer metastatic to bone already receiving zoledronic acid or pamidronate (and s/p at least 9 monthly doses) were randomized to continue receiving zoledronic acid infusions every 4 versus 12 weeks. The number of and median time to first skeletal-related events were not inferior in the experimental group receiving infusions one-third as often. Why does this matter? ASCO currently recommends routine use of a bone-modifying agent every 3-4 weeks indefinitely for these patients. And with women with metastatic breast cancer living longer than ever, careful consideration of long-term toxicities are more pertinent than ever. As we get smarter at treating cancer, we have to get smarter at treating survivors: and this is a bone-fide step in the right direction.